Direct surgical repair of spondylolysis in athletes: indications, techniques, and outcomes

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Athletes present with back pain as a common symptom. Various sports involve repetitive hyperextension of the spine along with axial loading and appear to predispose athletes to the spinal pathology spondylolysis. Many athletes with acute back pain require nonsurgical treatment methods; however, persistent recurrent back pain may indicate degenerative disc disease or spondylolysis. Young athletes have a greater incidence of spondylolysis. Surgical solutions are many, and yet there are relatively few data in the literature on both the techniques and outcomes of spondylolytic repair in athletes. In this study, the authors undertook a review of the surgical techniques and outcomes in the treatment of symptomatic spondylolysis in athletes.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A systematic review of the MEDLINE and PubMed databases was performed using the following key words to identify articles published between 1950 and 2011: “spondylolysis,” “pars fracture,” “repair,” “athlete,” and/or “sport.” Papers on both athletes and nonathletes were included in the review. Articles were read for data on methodology (retrospective vs prospective), type of treatment, number of patients, mean patient age, and mean follow-up.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Eighteen articles were included in the review. Eighty-four athletes and 279 nonathletes with a mean age of 20 and 21 years, respectively, composed the population under review. Most of the fractures occurred at L-5 in both patient groups, specifically 96% and 92%, respectively. The average follow-up period was 26 months for athletes and 86 months for nonathletes. According to the modified Henderson criteria, 84% (71 of 84) of the athletes returned to their sports activities. The time intervals until their return ranged from 5 to 12 months.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>For a young athlete with a symptomatic pars defect, any of the described techniques of repair would probably produce acceptable results. An appropriate preoperative workup is important. The ideal candidate is younger than 20 years with minimal or no listhesis and no degenerative changes of the disc. Limited participation in sports can be expected from 5 to 12 months postoperatively.</jats:p></jats:sec>

Management of spondylolysis and low-grade spondylolisthesis in fine athletes. A comprehensive review

“…There are several reports of outcomes of direct repair techniques in athletes with spondylolysis and spondylolisthesis [65][66][67][68]. The surgical techniques that are commonly used include interfragmentary screw fixation across the lytic defect, tension band constructs (wiring only), pedicle screw and wiring and pedicle screw and hook constructs [58] All these surgical techniques demonstrated excellent functional results with (Table 2). Although there are no level I comparative studies, it is obvious that direct pars repair may be advantageous in athletes because lower lumbar spine motion is preserved.…”

“…Increasing pain, worsening of preexisted neurological impairment and progressive olisthesis are also additional indications for surgical treatment [58]. The preoperative requirements for spondylolysis repair include healthy intervertebral disc (disc height C 2/3 of its normal height and slippage \ 10 mm) [58].…”

Comparison of surgical treatment with direct repair versus conservative treatment in young patients with spondylolysis: a prospective, comparative, clinical trial

“…Fortunately, most patients with spondylolysis can be managed conservatively [1,2]. However, some do not respond to conservative treatment and eventually require surgical treatment, such as direct repair (DR) of the pars defect [3][4][5][6][7][8][9][10][11]. Recently, DR for spondylolysis has gained popularity because of its inherent strengths compared with other surgical treatment methods, especially fusion surgery.…”

Comparison of lumbar discectomy alone and lumbar discectomy with direct repair of pars defect for patients with disc herniation and spondylolysis at the nearby lumbar segment

“…In the present study, we used the DR technique for the pars defect in patients with spondylolysis, as described by Buck [11]. This technique has been popularized as a surgical treatment for lumbar spondylolysis because it is relatively simple to perform and has fewer complications and great clinical and radiologic outcomes [18][19][20][21][22][23][24]. This study showed that additional DR after LD provided better outcomes in terms of pain intensity, as well as clinical and radiologic outcomes, than LD alone.…”